meet need with a profile for preference on the observation resource. Requirements are a preference category (nutrition, medication, care), the preference priority (high/medium/delayed from C-CDA) and with elements of expressor and recorder.

Tracking of reviews and plans for reviews is something that applies to many resources, not just CarePlan (e.g. protocols, standing orders, long term care admissions, etc.). This is something probably best handled by "Task" but will require a fair bit of analysis and discussion with other work groups to agree on approach. Defer to R4. Consider transfer to OO who owns Task

Meetings

Monday Q1

Approving the agenda of the current WGM. No additions and no corrections applied to the agenda.

Demo from Michel Rutten about the FHIR registry. Combine with L-froms on Thursday Q5. See HL7 wiki agenda.

DMP review: do we need to adjust the DMP?

Quorum: Our current DMP requires 3 persons. We still tend to keep this quorum to have enough diversity of standpoints.

Electronic voting: Our current DMP is identical to the standard DMP, but the section on the quorum does not seem viable, because it is difficult to calculate the 90% of a previous call or WGM.

3 options:

Stick to the default DMP (90% of last meeting)

Stick to the standard quorum. (co-chair +3, organizing person + 3))

Equal to the amount of co-chair ( 7 people).

Vote:

2 persons for option 1

4 persons for option 2

2 persons for option 3.

Option 2 prevails. This means that PCWG will divert for the default DMP and use the same calculation the standard quorum calculation.

Action Item for Michael Tan to add the adjustments to DMP.

Chat.HL7.org.

Wayne Kubrick has e-mailed a proposal to use Zulip as a chat platform.

A chat fills a need for fast moving discussions. The FHIR folks usually Zulip for this purpose. The speed of the chat is too high for normal discussion.

A list server discussion requires more structure and is more appropriate for a working group.

Most attendants prefer to stick to e-mails thru the list server. Zulip can still be used occasionally for certain events such as the Clinicians on FHIR.

Discussion on CIMI and the relationship with CDA.

The CIMI should be responsible for the content.

The CDA is more about infrastructure.

There should be a CIMI management board. CIMI would guard that a CIMI product would be consistent in CDA, FHIR or V2. This CIMI management group would resemble the FHIR management group.

There is a call for volunteers to join the CIMI chair. Jay is considering.

Amit Popat reminds the attendees of a request from Austin about the future of HL7v2. This is planned for Monday Q3. **Amit is assigned as the official representative of Patient Care WG.

Monday Q2

Chair: Michael Tan

Scribe: Jay Lyle

Brett Marquard presented an approach for modeling Notes in FHIR. After grappling with some of the content questions, the team decided that the key differentiator is structure, and that a Note is likely a chunk of text, a document, a reference to a resource, or a mixture of these. This approach defers the definition of note content, supporting a richer variety of use cases, while supporting the ability to identify notes via some classification such as the LOINC document ontology.

Most attendees felt this is a reasonable approach.

MM: also address state changes, e.g., signature

LM: docRef is for locating documents on servers. That could be changed.

Monday Q3

Monday Q4

Objective 1 - consistency in recording what need to be done with what was done

Objective 2 - to define and make clear to folks the different ways to ask for something to be done and not rely only on the request resource but to follow-up on whether it was done.

Workflow was to increase the consistency.

Focus for this session

Workflow reports that identified request or event patterns that need to be fully aligned or intentional not. Allows override. Some workgroups have done this. Impoertant to do this if hte resource is moving to normative (# or above)

Once that is done, the workflow project will review. Want to encourage consistency where they can get.

Look at the patterns - some changes have occurred since STU 3

exampleScenario resource - hope to have it publishable as part of STU4. A mechanism for seeing the different flows related to the original request.

Provide review of what exists in the workflow space

Review workflow space

Patterns - Request, Event

Workgroups should have received an xml file

for things that should not have the pattern applied paste into the suppressedIssues to make if clear this is a conscious decision to not apply the workflow pattern

Patterns should not drive decisions. Implementations should drive decisions.

For care plan - PC has a change request against carePlan.instantiates to have a reference + uri.

Governance question re: when are CIMI models approved? Ans = acceptance by the CIMI group, but also to ballot through HL7. The question is the level that gets balloted. Balloting works ok for the major patterns - but balloting each individual model will not work too well. It may need to be a crowdsourcing approach of reporting on successful use for those.

How do CIMI compliant claims get validated? - it is up to CIMI, validating models is not up to implementers - but there is not any type of process or people set up to approve these yet. That process needs to be determined and put in place. Will also need to look at how to validate equivalence.

Adverse Event update provided by Claude - work has started but it will be continuing, Please contact Claude Nanjo if you are interested to join future calls.

Tuesday Q2

Chair: Michelle MillerScribe: Emma Jones

Occupational data for health

Goal is to align with other resources

Has population health use

CDS alignment with these data elements.

FHIR resource in the ballot modeled around what was done in CDA.

Content

employment status

retirement status

combat zone

usual occupation

PastOrPresent Jobs

etc

New information trying to get into the clinical health record

Currently systems are collecting usual occupation for cancer reporting

Working with a couple of clinical settings about collecting the data - 3 engagements have been using work around

Billing collects some information but not for social history purposes

also have a functional profile htat is balloted

Valuesets harmonization is needed.

expectation is this data will be collected by EHRs

Case reporting - if there is an opportunity to collect the data there should be a means of getting the data collected

CDS - if patient has refractory diabetes, ask about their work - this is not the use case for this

Need to recognize there is a challenge for capturing the data in a clinical setting. Should Public Health be collecting this data directly?

Public Health does collect this data during an investigation. Illegal for collecting the data in advance

Working on a FHIR app so the patient can provide the data.

Also want to assist the care provider in facilitating awareness of certain predisposing situations

May not be collected by the care provider but can be collected by academia and schools

Is academia and school related work in scope for this resource?

Students was in the occupation scope but was removed because not within the boundary because it did not meet the definition of work (census does not record homemaker and student as occupations)

Do we need to expand the boundary for common practice? Could include based on local use. Need to define where the boundaries are.

Agreement on being transparent about scope

Suggest scope and boundaries around observation - as it relates to social history. The resource does not reference observation

Questionaire can contain social history

Observation can contain social history

could live in observation as an option (profile observation)

can use a profile to make the observation more specific to occupation data.

Next steps - either invite PC to PHER call if assistance needed or come to PC Thursday FHIR calls